PERINEUM The mechanism most commonly associated with trauma to the female perineum is a straddle-type injury These injuries may cause vulvar hematomas, which usually respond to treatment with ice packs and bed rest Patients experiencing mild urinary retention may be more comfortable voiding in a tub of warm water Massive or expanding hematomas may require surgical exploration and evacuation Superficial lacerations of the perineum can be treated conservatively at home with sitz baths Deep lacerations may extend into the rectum or urethra If the extent of injury cannot be easily defined, surgical consultation for examination under anesthesia should be requested Rectal injury requires a diverting colostomy Suprapubic cystostomy or primary repair should be performed if the urethra is disrupted Vaginal lacerations must be suspected in patients with severe trauma to the external genitalia or penetration by foreign object If a significant vaginal laceration is noted, endoscopy with sedation or general anesthesia is necessary for a full evaluation The possibility of extension into the urethra, bladder, or rectum must be investigated The vaginal laceration is debrided and repaired with fine absorbable sutures SEXUAL ABUSE When common accidental situations fail to explain certain genitourinary injuries, the possibility of sexual abuse should be considered Injuries resulting from sexual abuse include abrasions and hematomas in the penile shaft, vaginal lacerations, and perineal hematomas (see also Chapters 79 Vaginal Bleeding and 87 Child Abuse/Assault ) Suggested Readings and Key References Aihara R, Blansfield J, Millham FH, et al Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures J Trauma 2002;52:205–209 Alli MO, Singh B, Moodley J, et al Prospective evaluation of combined suprapubic and urethral catheterization to urethral drainage alone for intraperitoneal bladder injuries J Trauma 2003;55:1152–1154 Andrich D, Day AC, Mundy AR Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring BJU Int 2007;100:567–573 Black PC, Miller EA, Porter JR, et al Urethral and bladder neck injury associated with pelvic fracture in 25 female patients J Urol 2006;175:2140–2145